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Nursing homes urged to rethink drugging people with dementia

Stephen Samis, vice president of the Canadian Foundation for Healthcare Improvement, told the Star there are many more effective ways of managing so-called challenging behaviours that sometimes prompt doctors to prescribe inappropriate medications.
(CFHI)

Drug safety expert Dr. David Juurlink says the fact CFHI's work with long-term care homes was able to reduce antipsychotic prescribing as much as it did "is a testament to how overprescribed these drugs are in long-term care.”
(RENE JOHNSTON / TORONTO STAR) | Order this photo

A Canadian health organization is launching a call to action for long-term care homes, to change the culture of prescribing antipsychotics to residents who may not need them in the first place.

The Canadian Foundation for Healthcare Improvement hopes to shine a spotlight on non-pharmacological therapies for residents with dementia, which in turn could save money on prescriptions and hospital visits.

CFHI, a non-profit organization that collaborates with governments and health-care providers to improve the system, worked with 56 long-term care homes across the country between 2014 and 2015, taking seniors off antipsychotics that had not been appropriately prescribed.

The Ottawa-based organization released what it called “dramatic results” on Monday, including a decrease in falls by 20 per cent, verbal abusive behaviour by 33 per cent and physical abusive behaviour by 28 per cent, among the 416 residents involved.

Overall, CFHI said antipsychotics were discontinued for 36 per cent of the residents, and “significantly reduced” for 18 per cent.

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“What we’re really hoping for is to draw attention to the issue that we are inappropriately prescribing these antipsychotic medications to people living with dementia in long-term care,” Stephen Samis, CFHI vice-president for programs, told the Star.

“There are other, more effective ways of managing the so-called challenging behaviours that are exhibited and that cause people to be put on these medications.”

While acknowledging that some residents do need the medications, such as those with a diagnosis for psychosis, Samis pointed out that long-term care homes are inappropriately give them to individuals who have no such diagnosis as a short-term fix for aggressive behaviour.

“I often say that rarely do we put people in physical straitjackets, but these are really chemical straitjackets, and when you begin to work with people, you're releasing them and giving them the opportunity to be responsive again to the world around them,” he said.

Samis suggested alternative therapies for individuals, including gardening, music, and being with pets.

He said CFHI is looking to collaborate with homes in every province to reduce antipsychotic dependency. New Brunswick is already on board, he said, and CFHI will begin working with more homes in that province this week.

Brand names for the most common medications prescribed include Seroquel, Risperdal and Zyprexa. The drugs are not approved by Health Canada for dementia, and come with strong warnings from pharmaceutical companies.

But doctors are legally allowed to prescribe them “off-label,” meaning they can be used for a condition for which the drugs haven’t been approved.

A 2014 Star investigation found that Ontario nursing homes, many suffering from staffing shortages, were drugging seniors at an alarming rate, even though some antipsychotic drugs can increase the risk for death in elderly people with dementia.

At close to 300 homes, more than a third of the residents were on the drugs, the investigation found.

CFHI estimates that about 27 per cent of seniors in long-term care in Ontario are on antipsychotics without a diagnosis for psychosis, a figure nearly identical to the national average.

The organization estimates that five years of antipsychotic reduction programs in Ontario would cut 10 million drug prescriptions, save $13 million in antipsychotic prescription costs, and save $90 million in health care costs related to falls.

“For a province like Ontario, those are pretty significant savings,” Samis said.

David Juurlink, a drug safety expert and head of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre, said the CFHI numbers were “quite impressive,” particularly relating to the decrease in falls, the main cause of injury and hospitalization for seniors.

“The fact that they were able to reduce antipsychotic prescribing as much as they did is a testament to how overprescribed these drugs are in long-term care,” he said. “They are an important element of care for some patients, but they come with a host of side effects, some of them very serious. Often there are preferable drug- and non-drug alternatives.

“I think if those involved in the care of these patients, along with their families, asked ‘What exactly are we trying to accomplish with this drug?’ we'd see fewer prescriptions, the healthcare system would save a small fortune, and patients would be a lot better off.”

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